Metodologia da problematização no ensino remoto para debater sobre infecções sexualmente transmissíveis em idosos / Problematization methodology in remote teaching to discuss sexually transmitted infections in the elderly

Resumo Introdução: Atualmente o Brasil mostra um expressivo aumento da sobrevida e consequente elevação do número de idosos na sua população. Do ponto de vista de propostas para a melhoria da qualidade de vida deles, a sexualidade deve ser compreendida a partir do princípio holístico, não somente do fator biológico. Nesse cenário, novas reflexões de profissionais da saúde tornam-se indispensáveis para o planejamento de ações específicas, objetivando a atenção integral à saúde do idoso. Relato de experiência: O presente relato de experiência traz o início de um diálogo com acadêmicos de Medicina de uma universidade pública sobre a complexidade da sexualidade e infecções sexualmente transmissíveis (IST) em idosos, buscando identificar o conhecimento desses discentes sobre o assunto e idealizar propostas de ação ao público-alvo. Para isso, estruturou-se uma estratégia de ensino-aprendizagem cuja abordagem consistiu na adaptação e aplicação da metodologia do Arco de Maguerez para o debate sobre IST no contexto da saúde pública brasileira, o qual foi realizado com base nas diretrizes do ensino remoto emergencial. Nossos resultados vão de encontro à literatura que visa compreender as representações sociais acerca da sexualidade dos idosos. Neles, verificou-se que as representações sociais acerca da sexualidade na terceira idade assemelham-se à descrição científica, apresentado similitude entre o senso comum e o conhecimento erudito. Discussão: Diante da discrepância descrita na literatura quanto aos conceitos errôneos por parte dos idosos e dos familiares e pelos profissionais de saúde acerca da sexualidade na terceira idade, são imprescindíveis a realização de campanhas e o desenvolvimento de medidas e estratégias preventivas voltadas para idosos, a fim reduzir a incidência de IST nessa comunidade. Para isso, são fundamentais estratégias de educação em saúde no ensino acadêmico e de educação profissional continuada para sedimentar os conhecimentos necessários na idealização de propostas eficazes. Conclusão: A partir da formação médica adequada e por meio da discussão dos aspectos complexos sobre o assunto, serão possíveis a construção, a implementação e a avaliação de políticas públicas de saúde para o enfrentamento das IST, de modo a diminuir as barreiras relacionadas à prevenção de doenças e à promoção de saúde sexual na população idosa.

Abstract Introduction: Brazil is currently reporting a significant increase in survival and consequent rise in its elderly population. From the point of view of proposals to improve their quality of life, sexuality should be understood from a holistic, and not just a biological, perspective. In this scenario, new reflections by health professionals become indispensable for the planning of specific actions aimed at providing comprehensive health care for the elderly. Experience report: This experience report describes the beginning of a dialogue with medical students from a public university about the complexity of sexuality and sexually transmitted infections among the elderly, seeking to identify their knowledge of the subject and devise proposals for action with the target audience. To this end a teaching-learning strategy was structured based on an approach that adapted and applied the Arc of Maguerez methodology to the debate on sexually transmitted infections (STIs) in the context of Brazilian public health, which was conducted out within the guidelines of emergency remote learning. Our results are in line with the literature that seeks to understand the social representations about sexuality among the elderly. It was found that the social representations about sexuality in the elderly are similar to the scientific description, with similarities between common sense and scholarly knowledge. Discussion: Given the discrepancy described in the literature regarding the misconceptions on the part of the elderly, family members and health professionals about sexuality in old age, it is essential that campaigns be conducted, and preventive measures and strategies developed for the elderly to reduce the incidence of STIs in this community. Hence, health education strategies are needed in academic teaching and continuing professional education to consolidate the knowledge required to devise effective proposals. Conclusions: Based on fit-for-purpose medical education, the discussion of complex aspects about this subject will support the construction, implementation, and evaluation of public health policies to tackle STIs, reducing barriers related to the prevention and promotion of sexual health in the elderly population.

High frequency of WNT-activated medulloblastomas with CTNNB1 wild type suggests a higher proportion of hereditary cases in a Latin-Iberian population.

Purpose: Medulloblastomas are the most common primary malignant brain tumors in children. They are divided into molecular subgroups: WNT-activated, SHH-Activated, TP53 mutant or wild type, and non-WNT/non-SHH (Groups 3 and 4). WNT-activated medulloblastomas are usually caused by mutations in the CTNNB1 gene (85%-90%), and most remaining cases of CTNNB1 wild type are thought to be caused by germline mutations in APC. So far, the frequencies of CTNNB1 have been reported mainly in North American and European populations. The aim of this study was to report the frequency of CTNNB1 mutations in WNT-activated medulloblastomas in a Latin-Iberian population and correlate with their clinicopathological characteristics. Methods: A total of 266 medulloblastomas from seven different institutions from Brazil (n=211), Portugal (n=38), and Argentina (n=17) were evaluated. Following RNA and DNA isolation from formalin-fixed, paraffin-embedded (FFPE) tumor tissues, the molecular classification and CTNNB1 mutation analysis were performed by nCounter and Sanger sequencing, respectively. Results: WNT-activated medulloblastomas accounted for 15% (40/266) of the series. We observed that 73% of WNT-activated medulloblastomas harbored CTNNB1 mutations. CTNNB1 wild-type cases (27%) were more prevalent in female individuals and suggested to be associated with a worse outcome. Among the CTNNB1 wild-type cases, the available analysis of family history revealed two cases with familiar adenomatous polyposis, harboring APC germline variants. Conclusion: We observed a lower incidence of CTNNB1 mutations in WNT-activated medulloblastomas in our Latin-Iberian cohort compared to frequencies previously described in other populations. Considering that CTNNB1 wild-type cases may exhibit APC germline mutations, our study suggests a higher incidence (~30%) of hereditary WNT-activated medulloblastomas in the Latin-Iberian population.

Navigating the Blood-Brain Barrier: Challenges and Therapeutic Strategies in Breast Cancer Brain Metastases.

Breast cancer (BC) is the most common cancer in women, with metastatic BC being responsible for the highest number of deaths. A frequent site for BC metastasis is the brain. Brain metastasis derived from BC involves the cooperation of multiple genetic, epigenetic, angiogenic, and tumor-stroma interactions. Most of these interactions provide a unique opportunity for development of new therapeutic targets. Potentially targetable signaling pathways are Notch, Wnt, and the epidermal growth factor receptors signaling pathways, all of which are linked to driving BC brain metastasis (BCBM). However, a major challenge in treating brain metastasis remains the blood-brain barrier (BBB). This barrier restricts the access of unwanted molecules, cells, and targeted therapies to the brain parenchyma. Moreover, current therapies to treat brain metastases, such as stereotactic radiosurgery and whole-brain radiotherapy, have limited efficacy. Promising new drugs like phosphatase and kinase modulators, as well as BBB disruptors and immunotherapeutic strategies, have shown the potential to ease the disease in preclinical studies, but remain limited by multiple resistance mechanisms. This review summarizes some of the current understanding of the mechanisms involved in BC brain metastasis and highlights current challenges as well as opportunities in strategic designs of potentially successful future therapies.

Consecutive Inhibition of Telomerase and Alternative Lengthening Pathway Promotes Hodgkin's Lymphoma Cell Death.

Telomere maintenance is key during cancer development. Malignant cells can either use telomerase or an alternative lengthening of telomere (ALT) pathway to maintain their telomere length. In Hodgkin's Lymphoma (HL), the presence of telomerase activation is established. The activation of ALT has been reported recently. Our data confirm this notion describing co-localization of the phosphorylated form of telomeric repeat-binding factor 1 (pT371-TRF1) with ALT-associated promyelocytic leukemia bodies. Surprisingly, to our knowledge, there are no published studies targeting both telomere maintenance pathways in HL. Consequently, we investigated, for the first time, the effects of both telomerase and ALT inhibition on HL cell viability: We inhibited telomerase and/or ALT, given either individually, simultaneously, or consecutively. We report that the inhibition of telomerase using BIBR1532 followed by ALT inhibition, using trabectedin, caused a decrease of greater than 90% in cell viability in three patient-derived HL cell lines. Our results suggest that HL cells are most vulnerable to the consecutive inhibition of telomerase followed by ALT inhibition.

Chromosome Territories in Hematological Malignancies.

Chromosomes are organized in distinct nuclear areas designated as chromosome territories (CT). The structural formation of CT is a consequence of chromatin packaging and organization that ultimately affects cell function. Chromosome positioning can identify structural signatures of genomic organization, especially for diseases where changes in gene expression contribute to a given phenotype. The study of CT in hematological diseases revealed chromosome position as an important factor for specific chromosome translocations. In this review, we highlight the history of CT theory, current knowledge on possible clinical applications of CT analysis, and the impact of CT in the development of hematological neoplasia such as multiple myeloma, leukemia, and lymphomas. Accumulating data on nuclear architecture in cancer allow one to propose the three-dimensional nuclear genomic landscape as a novel cancer biomarker for the future.

Single nCounter assay for prediction of MYCN amplification and molecular classification of medulloblastomas: a multicentric study.

PURPOSE: Medulloblastoma is the most frequent pediatric malignant brain tumor, and is divided into four main subgroups: WNT, SHH, group 3, and group 4. MYCN amplification is an important medulloblastoma prognostic biomarker. We aimed to molecular classify and predict MYCN amplification in a single assay. METHODS: It was included 209 medulloblastomas from 205 patients (Brazil, Argentina, and Portugal), divided into training (n = 50) and validation (n = 159) sets. A nCounter assay was carried out using a custom panel for molecular classification, with additional genes, including MYCN. nSolver 4.0 software and the R environment were used for profiling and MYCN mRNA analysis. MYCN amplification by FISH was performed in 64 cases. RESULTS: The 205 medulloblastomas were classified in SHH (44.9%), WNT (15.6%), group 3 (18.1%) and group 4 (21.4%). In the training set, MYCN amplification was detected in three SHH medulloblastomas by FISH, which showed significantly higher MYCN mRNA counts than non-FISH amplified cases, and a cutoff for MYCN amplification was established ([Formula: see text] + 4σ = 11,124.3). Applying this threshold value in the validation set, we identified MYCN mRNA counts above the cutoff in three cases, which were FISH validated. CONCLUSION: We successfully stratified medulloblastoma molecular subgroups and predicted MYCN amplification using a single nCounter assay without the requirement of additional biological tissue, costs, or bench time.

Proteinuria and serum creatinine after 12 months of treatment for lupus nephritis as predictors of long-term renal outcome: a case-control study.

BACKGROUND: Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10-25% of patients progressing to end-stage renal disease (ESRD). OBJECTIVE: This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients. METHODS: A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes. RESULTS: The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61). CONCLUSIONS: In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.

Liquid-based cytology and HPV DNA test in anal specimens from women with cervical cancer.

INTRODUCTION: Cervical and anus cancers have similarities: association with HPV infection, epithelial transformation zone, and precursor lesions. However, it is still unclear whether women with cervical cancer should be screened to identify high-grade squamous intraepithelial lesions and anal cancer. We aimed to identify high-risk HPV and cytological atypia in anal samples from women diagnosed with invasive squamous cell carcinoma of the cervix. STUDY DESIGN: We conducted a cross-sectional study between July 2016 and August 2017 in reference services in oncology in the State of Ceará, Brazil. We studied 59 patients diagnosed with frankly invasive squamous cell carcinoma of the cervix (at least stages IB) and 60 women in a control group. We performed liquid-based cytology (Surepath™) and HPV test (Cobas® 4800 System Test) of anal samples. To determine statistical significance with a confidence interval of 95%, we used Fisher's exact test and Student's t-test using the GraphPad Prism 7.0 software. RESULTS: The mean age in the control group was 56.7 ± 8.5 years, while in the group of women with cervical squamous cancer, it was 54.3 ± 14.8. The liquid-based cytology results of the satisfactory cases were: negative for intraepithelial lesion or malignancy (NLM): 51 cases (85%) in the control group and 38 (64.4%) in the study group (p = .0116). The HPV test was negative more frequently in the control group (n = 56, 93.3%) than in the study group (n = 17, 31.5%) (p < .0001). HPV 16 was the most frequent type (67.6%). CONCLUSIONS: There is a higher frequency of high-risk HPV and atypical cytology in women with cervical cancer than without lesions. Thus, this group should be considered as a target population for screening.

The influence of the rib cage on the severity of thoracic spine burst fractures / Influência da caixa torácica na gravidade da fratura da coluna torácica tipo explosão / La influencia de la caja torácica en la gravedad de la fractura por estallido en la columna torácica

ABSTRACT Objective: To analyze the anatomic influence of the ribs related to the severity of thoracic spine burst fractures. Methods: A retrospective review of 28 patients with thoracic spine burst fractures hospitalized by the Spine Group of the Hospital Ortopédico de Passo Fundo between January 2002 and December 2016 was conducted. The kyphosis, vertebral collapse, and narrowing of the vertebral canal measurements were compared between patients who had fractures at the true and false rib levels (T1 to T10) and those with fractures at the floating rib levels (T11 to T12). Results: The kyphosis, vertebral collapse, and narrowing of the vertebral canal values, measured only for vertebrae pertaining to the rib cage, were low. In addition, there were no statistically significant differences between the measurements of the group of patients with fractures at the level of the true and false ribs (T1 to T10) and the group of patients whose fractures were at the level of the floating ribs (T11 and T12). Conclusion: The differences between the traumatic structural changes in the vertebrae with true and false ribs (T1 to T10) and the vertebrae with floating ribs (T11 and T12) were not significant in the present study. Level of Evidence II; Retrospective study.

RESUMO Objetivo: Analisar a influência anatômica das costelas sobre a gravidade das fraturas da coluna torácica tipo explosão. Métodos: Foi realizada uma revisão retrospectiva de 28 pacientes com fratura tipo explosão na coluna torácica, internados no período compreendido entre janeiro de 2002 a dezembro de 2016 pelo Grupo de Coluna do Hospital Ortopédico de Passo Fundo . As mensurações de cifose, colapso vertebral e estreitamento do canal vertebral foram comparadas entre os pacientes que apresentavam fraturas no nível das costelas verdadeiras ou falsas (T1 a T10) e aqueles com fraturas no nível das costelas flutuantes (T11 a T12). Resultados: Os valores da cifose, colapso vertebral e estreitamento do canal vertebral, mensurados apenas nas vértebras pertencentes à caixa torácica, mostraram-se baixos. Além disso, as mensurações não apresentaram diferenças estatísticas significativas quando foram comparados os grupos de pacientes que apresentavam fraturas no nível das costelas verdadeiras ou falsas (T1 a T10) com aqueles cujas fraturas eram no nível das costelas flutuantes (T11 e T12). Conclusões: As diferenças entre as alterações estruturais traumáticas nas vértebras com costelas verdadeiras e falsas (T1 a T10) e as vértebras com costelas flutuantes (T11 e T12) não foram significativas no presente estudo. Nível de Evidência II; Estudo retrospectivo.

RESUMEN Objetivo: Analizar la influencia anatómica de las costillas con respecto a la gravedad de las fracturas de la columna torácica por estallido. Métodos: Se realizó una revisión retrospectiva de 28 pacientes con fractura de columna torácica por estallido, ingresados en el período comprendido entre enero de 2002 y diciembre de 2016 por el Grupo de Columna del Hospital Ortopédico de Passo Fundo. Se compararon las medidas de cifosis, colapso vertebral y estrechamiento del conducto vertebral entre los pacientes que presentaban fracturas a nivel de las costillas verdaderas o falsas (T1 a T10) y aquellos con fracturas a nivel de las costillas flotantes (T11 a T12). Resultados: Los valores de cifosis, colapso vertebral y estrechamiento del conducto vertebral, medidos solamente en las vértebras pertenecientes a la caja torácica, se mostraron bajos. Además, las mediciones no presentaron diferencias estadísticamente significativas al comparar los grupos de pacientes que presentaban fracturas a nivel de las costillas verdaderas o falsas (T1 a T10) con aquellos cuyas fracturas estaban a nivel de las costillas flotantes (T11 a T12). Conclusiones: Las diferencias entre los cambios estructurales traumáticos en las vértebras con costillas verdaderas y falsas (T1 a T10) y las vértebras con costillas flotantes (T11 y T12) no fueron significativas en el presente estudio. Nivel de Evidencia II; Estudio retrospectivo.

Proteinuria and serum creatinine after 12 months of treatment for lupus nephritis as predictors of long-term renal outcome: a case-control study

Abstract Background: Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10-25% of patients progressing to end-stage renal disease (ESRD). Objective: This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients. Methods: A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes. Results: The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61). Conclusions: In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.

Central nervous system high-grade neuroepithelial tumor with BCOR alteration: a short report

Central nervous system high-grade neuroepithelial tumors with BCOR alteration are rare. Currently, there are only 24 cases reported in the literature. These tumors are characterized by a change involving the BCOR gene and have a poor prognosis. Studies are needed to improve the current therapy and outcomes of these neoplasms. This case report describes the clinical history of a patient with this disease and aims to contribute to the current knowledge about this new entity.

Avaliação da linguagem em cirurgia de craniotomia com paciente acordado: relato de caso / Language assessment in awake craniotomy: case report

RESUMO O objetivo deste relato foi descrever o caso de um paciente submetido à craniotomia, acordado, para a ressecção neurocirúrgica de um glioma e a avaliação linguística pré-operatória, intraoperatória e pós-operatória. Paciente do gênero masculino, 27 anos, escolaridade nível superior incompleto, apresentando vômitos, confusão mental e crise convulsiva tônico-clônica. Após a avaliação do paciente pela equipe e devidas orientações pré-operatórias, a proposta de excisão da lesão em estado de vigília foi esclarecida e aceita. Ao iniciar o procedimento, os campos foram ajustados para manter as vias aéreas e os olhos acessíveis para mapeamento com estimulação elétrica e avaliação da linguagem no período intraoperatório. Devido à localização do tumor próximo à área motora da fala, foram propostas tarefas para a avaliação da linguagem em quatro momentos: pré-operatório, intraoperatório, pós-operatório imediato e pós-operatório mediato. As habilidades linguísticas testadas nas quatro avaliações foram: compreensão e expressão da linguagem oral, transposição linguística, linguagem associativa, nomeação, discriminação visual, fluência e organização da sintaxe. Com o objetivo de controlar e eliminar o efeito de aprendizagem da testagem, foram solicitadas as mesmas tarefas, porém, com diferentes conteúdos para a testagem das habilidades nas quatro fases. A cirurgia com o paciente acordado permitiu a ressecção completa e segura do tumor, sem prejuízo motor ou linguístico. O engajamento da equipe, a interação interdisciplinar e o planejamento cirúrgico detalhado constituem um pilar para o bom resultado de um procedimento tão complexo e delicado.

ABSTRACT The purpose of this report is to describe the case of a patient who underwent awake craniotomy for neurosurgical resection of a glioma and pre, intra and postoperative linguistic assessment. Male patient, 27 years old, incomplete higher education presenting vomiting, mental confusion and tonic-clonic seizures. After the evaluation of the patient by the team and due preoperative guidance, the proposal of excision of the lesion while awake was clarified and accepted. At the start of the procedure, the fields were adjusted to keep the airway and eyes accessible for mapping with electrical stimulation and intraoperative language assessment. Due to the location of the tumor close to the speech motor area, tasks were proposed for the assessment of language in four moments: preoperative, intraoperative, immediate postoperative and mediate postoperative. The language skills tested in the four assessments were: comprehension and expression of oral language, linguistic transposition, associative language, naming, visual discrimination, fluency and syntax organization. In order to control and eliminate the learning effect of testing, the same tasks were requested, but with different contents for testing skills in the four phases. Surgery with the patient awake allowed the complete and safe resection of the tumor, without motor or linguistic damage to the patient. Team engagement, interdisciplinary interaction and detailed surgical planning constitute the pillar for the good result of such a complex and delicate procedure

Calibração de hidrômetro para água fria de vazão nominal de 1,5 m3/h / Calibration of hydrometer for cold water of nominal flow of 1,5 m3/h

RESUMO Com a crise hídrica vivida na atualidade, as concessionárias de água têm buscado soluções para diminuir as perdas de água. No sistema de abastecimento de água podem acontecer dois tipos, as perdas reais — ocasionadas por vazamentos na tubulação, transbordamentos e vazamentos nos reservatórios — e as perdas aparentes — causadas por fraudes, ligações clandestinas e erros de submedição dos hidrômetros. O acompanhamento periódico da confiabilidade metrológica dos hidrômetros, por meio de calibração, permite o apoio na decisão pela troca, ou não, reduzindo, assim, as perdas aparentes. Dessa forma, este artigo apresenta um método para calibração de hidrômetro para água fria, taquimétrico, monojato, classe B, de vazão nominal de 1,5 m3/h, tipo de medidor mais utilizado nas ligações residenciais, por meio da Portaria do INMETRO de nº 246, de 17 de outubro de 2000. O método proposto apresenta as condições para preparação dos medidores e da bancada, o sistema de medição, as possíveis fontes dos erros e suas respectivas incertezas associadas. Além do método de cálculo de incerteza de medição, conforme preconiza o guia para a expressão de incerteza de medição (GUM) da ISO, publicado em 2008. Foi realizada a calibração de três hidrômetros usados, fabricados nos anos de 2015, 2016 e 2017 e escolhidos aleatoriamente no parque de hidrômetros do município de Recife, gerido pela Companhia Pernambucana de Saneamento (COMPESA). Os resultados obtidos demonstram a viabilidade do método no apoio na troca dos hidrômetros pela análise comparativa entre os valores de referência do INMETRO e os medidos somados às incertezas.

ABSTRACT With the current water crisis, water companies have been joining efforts to find solutions to reduce water losses. In a water supply system, there can be two types of losses, the real ones — caused by pipe leaks, tank leaks, and overflows in the reservoirs — and the apparent losses — caused by fraud, illegal connections, and metering inaccuracies. The periodic monitoring of the metrological reliability of the water meters through calibration allows supporting the decision on whether or not to change these water meters, thus reducing apparent losses. Therefore, this paper presented a method for calibrating the cold water, tachometer, monojate, class B water meters, with a nominal flow rate of 1.5 m3/h, the most commonly used type of meter for residential connections, through the INMETRO Ordinance No. 246, October 17, 2000. The proposed method presents the conditions for meter and bench preparation, the measurement system, the possible sources of errors, and their associated uncertainties. In addition to the measurement uncertainty calculation method, as recommended by the ISO Guideline for Measurement Uncertainty Expression (GUM), published in 2008. Three water meters in use, from the Pernambuco water company (COMPESA), manufactured in 2015, 2016, and 2017, were calibrated using the proposed method and bench. The results obtained demonstrate the viability of the method to support the change of water meters in the comparative analysis between INMETRO reference values and the measured value corrected with uncertainties.

A rare case of Ewing sarcoma metastasis to the oral cavity.

Ewing sarcoma in the head and neck is rare, and metastasis from other bones to the mandible accounts for 0.7% of cases. This report presents a case of oral metastasis in a 24-year-old male patient diagnosed with Ewing sarcoma of the femur (p53 gene mutation and EWSR1-ERG fusion). The chief complaint was numbness in the mandible and pain for 1 month and a hardened, ulcerated exophytic lesion in the right retromolar region. Imaging exams revealed an unspecified thinning of the cortical bone of the inferior alveolar canal in the right mandibular ramus, associated with erosion of the alveolar bone. Histopathological analysis confirmed metastasis of Ewing sarcoma. The patient presented an aggressive disease progression and died 1 month after the oral diagnosis. It is important to recognize the signs and symptoms compatible with rare clinical outcomes, leading to an early diagnosis that can improve patients' quality of life and survival.

Liraglutide treatment counteracts alterations in adipose tissue metabolism induced by orchiectomy in rats.

AIMS: The reduction in androgens serum concentration is a physiological condition that accompanies age advancement but can also occur because of prostate cancer and gender affirming treatment or pathological conditions such as functional hypogonadism. However, androgen deficiency is related to a higher risk of developing metabolic disorders such as obesity and type 2 diabetes mellitus (T2DM). Considering that glucagon-like peptide 1 (GLP1) analogs are increasingly used in the treatment of T2DM, we investigated if liraglutide could also attenuate the metabolic changes caused by orchiectomy in rats. MAIN METHODS: Wistar rats were orchiectomized (ORC), and subdivided in four groups: sham saline, sham liraglutide, ORC saline, and ORC liraglutide. After sixty days, metabolic parameters were evaluated in blood, muscle, liver, brown (BAT) and white adipose tissue (WAT) visceral depots. Glucose utilization, oxidation, and conversion to lipids by de novo lipogenesis, and basal and adrenaline-stimulated lipolysis were evaluated in BAT and WAT depots. KEY FINDINGS: Orchiectomy increased triglyceridemia, BAT and rtWAT weight, and lipolysis and reduced glucose utilization. Liraglutide treatment reversed these effects. SIGNIFICANCE: These results indicate that liraglutide improves triglyceridemia and glucose metabolism in WAT depots, which suggests that it may be a promising therapeutic strategy to handle disruptions in energy metabolism caused by androgen deficiency.

Adipose tissue of female Wistar rats respond to Ilex paraguariensis treatment after ovariectomy surgery.

BACKGROUND AND AIM: Metabolic disturbances are known for their increasing epidemiological importance. Ilex paraguariensis presents a potential option for mitigating lipid metabolism imbalance. However, most of the literature to date has not considered sex bias. This study aimed to evaluate the effect of Ilex paraguariensis on the metabolism of different adipose tissue depots in males and females. EXPERIMENTAL PROCEDURE: After ovariectomy, female Wistar rats received daily treatment with the extract (1 g/kg) for forty-five days. Biochemical serum parameters and tissue metabolism were evaluated. Oxidation, lipogenesis and lipolysis were evaluated in brown, white visceral, retroperitoneal and gonadal adipose tissues. RESULTS AND CONCLUSION: The results showed that treatment with the extract led to a reduced weight gain in ovariectomised females in comparison to control. The triglyceride concentration was decreased in males. Glucose oxidation and lipid synthesis in visceral and retroperitoneal adipose tissues were restored in ovariectomised females after treatment. The response to epinephrine decreased in visceral adipose tissue of control males; however, lipolysis in females did not respond to ovariectomy or treatment. These findings highlight the enormous potential effects of I. paraguariensis on lipid metabolism, modulating lipogenic pathways in females and lipolytic pathways in males. Furthermore, the sex approach applied in this study contributes to more effective screening of the effects of I. paraguariensis bioactive substances.

Mandible lymphoma: an aggressive osteolytic lesion

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-hodgkin's lymphoma. In oral cavity represents approximately 2% of all malignancies. Case presentation: This report describes a rare mandibular involvement of DLBCL. A 56 year-old man was referred for evaluation of left mandible pain. In the anamnesis, the patient informed to be treating tooth pain in lasting 6 months. On oral evaluation, an intense mobility of the left mandibular second molar and a swelling in posterior left mandible were observed. Computed tomography showed a large osteolytic lesion affecting both mandibular body and ramus. An incisional biopsy was performed and according to histopathological and imumnohistochemical features, DLBCL was diagnosed. The treatment consisted of 8 cycles of R-CHOP and adjuvant radiotherapy. He is asymptomatic after 6 years. Conclusion: This case showed a rare bone presentation of DLBCL and such tumor should be considered as differential diagnosis of osteolytic lesion of the mandible.

Venous Thromboembolism Prevention Protocol Experience of 2000 Cases in Total Knee Arthroplasty* / Protocolo de prevenção do tromboembolismo venoso Experiência de 2000 casos em artroplastia total de joelho*

Abstract Objective The objective of the present study is to evaluate the impact evaluate the impact of an institutional protocol on a tertiary hospital for the prevention of venous thromboembolism in 2005 patients submitted to primary total knee arthroplasty (TKA). Methods Data from medical records of patients submitted TKA before (n= 1,115) and after (n= 890) the implementation of the institutional protocol, totaling 2,005 patients, were retrospectively reported. Demographics, comorbidities, and outcomes were analyzed. Results There was no significant change in the cases of deep venous thrombosis (DVT) (1.6% versus 2.4%; p= 0.211). There was an increase in cases of pulmonary embolism (PE) (0.2% versus 0.8% p= 0.049). Conclusion Despite the implementation of the prevention protocol, no reduction in the studied events was observed. The small global incidence makes further studies with larger series necessary to confirm or rule out these findings.

Resumo Objetivo O objetivo do presente estudo é avaliar o impacto de um protocolo institucional em um hospital terciário na prevenção do tromboembolismo venoso em 2.005 pacientes submetidos a artroplastia total primária de joelho. Métodos Os dados dos prontuários de pacientes submetidos a artroplastia total do joelho antes (n= 1.115) e após (n= 890) a implantação do protocolo institucional, totalizando 2.005 pacientes, foram relatados retrospectivamente. Dados demográficos, comorbidades e desfechos foram analisados. Resultados Não houve alteração significativa nos casos de trombose venosa profunda (TVP) (1,6% versus 2,4%; p= 0,211). Houve um aumento nos casos de embolia pulmonar (EP) (0,2% versus 0,8%; p= 0,049). Conclusão Apesar da implementação do protocolo de prevenção, não houve redução nos eventos estudados. A pequena incidência global faz com que novos estudos, com séries maiores, sejam necessários para confirmar ou descartar esses achados.

Expression of GNAS, TP53, and PTEN Improves the Patient Prognostication in Sonic Hedgehog (SHH) Medulloblastoma Subgroup.

Medulloblastoma (MB) is the most common malignant brain tumor in children. It is currently classified in four main molecular subgroups with different clinical outcomes: sonic hedgehog, wingless, group 3, and group 4 (MBSHH, MBWNT, MBGRP3, or MBGRP4). Presently, a 22-gene expression panel has been efficiently applied for molecular subgrouping using nCounter technology. In this study, formalin-fixed, paraffin-embedded samples from 164 Brazilian medulloblastomas were evaluated, applying the 22-gene panel, and subclassified into the low and high expression of nine key medulloblastoma-related genes. In addition, TP53 mutation status was assessed using TruSight Tumor 15 Panel, and its correlation with expression and prognostic impact was evaluated. Samples from 149 of 164 patients (90%) were classified into MBSHH (47.7%), MBWNT (16.1%), MBGRP3 (15.4%), and MBGRP4 (20.8%). GNAS presented the highest expression levels, with higher expression in MBSHH. TP53, MYCN, SOX2, and MET were also up-regulated in MBSHH, whereas PTEN was up-regulated in MBGRP4. GNAS, TP53, and PTEN low expression was associated with the unfavorable patient outcome only for MBSHH (P = 0.04, P = 0.01, and P = 0.02, respectively). TP53 mutations were detected in 28.57% of MBSHH cases and exhibited association with lower expression and worse clinical outcome, although not statistically significant. The 22-gene panel for molecular classification of medulloblastoma associated with the expression of GNAS, TP53, and PTEN improves the patient prognostication in MBSHH subgroup and can be easily incorporated in the 22-gene panel without any additional costs.

Auditory learning in an operant task with social reinforcement is dependent on neuroestrogen synthesis in the male songbird auditory cortex.

Animals continually assess their environment for cues associated with threats, competitors, allies, mates or prey, and experience is crucial for those associations. The auditory cortex is important for these computations to enable valence assignment and associative learning. The caudomedial nidopallium (NCM) is part of the songbird auditory association cortex and it is implicated in juvenile song learning, song memorization, and song perception. Like human auditory cortex, NCM is a site of action of estradiol (E2) and is enriched with the enzyme aromatase (E2-synthase). However, it is unclear how E2 modulates auditory learning and perception in the vertebrate auditory cortex. In this study we employ a novel, auditory-dependent operant task governed by social reinforcement to test the hypothesis that neuro-E2 synthesis supports auditory learning in adult male zebra finches. We show that local suppression of aromatase activity in NCM disrupts auditory association learning. By contrast, post-learning performance is unaffected by either NCM aromatase blockade or NCM pharmacological inactivation, suggesting that NCM E2 production and even NCM itself are not required for post-learning auditory discrimination or memory retrieval. Therefore, neuroestrogen synthesis in auditory cortex supports the association between sounds and behaviorally relevant consequences.